Effect Measure

Effect Measure is a forum for progressive public health discussion and argument as well as a source of public health information from around the web that interests the Editor(s)

Monday, January 31, 2005

Plus ça change . . .

Not everyone who reads this site will remember 1967. I remember it vividly (and not fondly). Another war. Another election. But the same old crap. Here, courtesy a blogger at Daily Kos (via Empire Notes) is the entire article in the New York Times, reporting from that (not so distant) time:

WASHINGTON, Sept. 3-- United States officials were surprised and heartened today at the size of turnout in South Vietnam's presidential election despite a Vietcong terrorist campaign to disrupt the voting.

According to reports from Saigon, 83 per cent of the 5.85 million registered voters cast their ballots yesterday. Many of them risked reprisals threatened by the Vietcong.

The size of the popular vote and the inability of the Vietcong to destroy the election machinery were the two salient facts in a preliminary assessment of the nation election based on the incomplete returns reaching here.

The size of the popular vote and the inability of the Vietcong to destroy the election machinery were the two salient facts in a preliminary assessment of the nation election based on the incomplete returns reaching here.

Pending more detailed reports, neither the State Department nor the White House would comment on the balloting or the victory of the military candidates, Lieut. Gen. Nguyen Van Thieu, who was running for president, and Premier Nguyen Cao Ky, the candidate for vice president.

A successful election has long been seen as the keystone in President Johnson's policy of encouraging the growth of constitutional processes in South Vietnam. The election was the culmination of a constitutional development that began in January, 1966, to which President Johnson gave his personal commitment when he met Premier Ky and General Thieu, the chief of state, in Honolulu in February.

The purpose of the voting was to give legitimacy to the Saigon Government, which has been founded only on coups and power plays since November, 1963, when President Ngo Dinh Diem was overthrown by a military junta.

Few members of that junta are still around, most having been ousted or exiled in subsequent shifts of power.

Significance Not Diminished

The fact that the backing of the electorate has gone to the generals who have been ruling South Vietnam for the last two years does not, in the Administration's view, diminish the significance of the constitutional step that has been taken.

The hope here is that the new government will be able to maneuver with a confidence and legitimacy long lacking in South Vietnamese politics. That hope could have been dashed either by a small turnout, indicating widespread scorn or a lack of interest in constitutional development, or by the Vietcong's disruption of the balloting.

American officials had hoped for an 80 per cent turnout. That was the figure in the election in September for the Constituent Assembly. Seventy-eight per cent of the registered voters went to the polls in elections for local officials last spring.

Before the results of the presidential election started to come in, the American officials warned that the turnout might be less than 80 per cent because the polling place would be open for two or three hours less than in the election a year ago. The turnout of 83 per cent was a welcome surprise. The turnout in the 1964 United States Presidential election was 62 per cent.

Captured documents and interrogations indicated in the last week a serious concern among Vietcong leaders that a major effort would be required to render the election meaningless. This effort has not succeeded, judging from the reports from Saigon.

You can read some pertinent commentary on similarities and differences with Iraq here.

Bird flu: quick weekend update (1/29 -1/31)

Quick survey of weekend developments:

Two more deaths, including a Cambodian woman who came over the border to Vietnam to get treated. Suspect case in Central Highlands (first such report) and seven suspect cases in Hanoi hospitals. No confirmation yet on Cambodian death or the others regarding H5N1, but it is considered likely.

Update (2/1/05): H5N1 infection as a cause of death has been confirmed in the woman from Cambodia.

Vietnam to host a regional meeting late in February from bird flu affected countries

The United Nations Food and Agriculture Organization and the World Organization for Animal Health will sponsor the meeting in Ho Chi Minh City from Feb. 23 to 25, according to the food agency representative in Vietnam, Anton Rychener. "Participants will discuss the control of the outbreak and the measures that could possibly be undertaken," Rychener said. (International Herald Tribune)

There are no details as to which countries will attend but last February (2004) 23 countries met in Bangkok under similar circumstances to discuss culling strategies, surveillance, carcass disposal and similar issues related to the poultry epidemic. This year's meeting will also likely look at public health issues. Twelve confirmed H5N1 deaths have occurred so far this year, all in Vietnam. The number continues to climb.

The disease continues to spread among poultry in Thailand, now involving six provinces. That country saw 12 deaths in last year's outbreak and is on high alert for human cases. (News24, South Africa).

In Vietnam 31 of 64 provinces are currently involved and almost 1 million birds have been culled. Hanoi now has a central slaughterhouse at the city's largest poultry market. Sales are usually high during the Tet (Lunar New Year) Holiday but are down 50% in the last two weeks. Last year's ban on sale and transport of poultry has yet to be repeated but birds without health certificates are being confiscated and destroyed (via Irish Examiner).

Stun guns: bird flu's evil twin?

What do stun guns like the Taser (other posts here, here and here) and bird flu have in common? Nothing really, except an interesting mirror image relationship in the ages at risk. Bird flu mainly strikes teenagers and young adults, in contrast to the usual endemic human influenza that kills the very young and very old. Stun guns are designed to be used on teenagers and young adults but now are being used on the very young and the very old.

Consider:

Police in Rock Hill, South Carolina used a Taser on a 75 year old woman in a nursing home when the woman, a distraught visitor who couldn't find her sick friend, refused to leave. The woman was further charged with trespass and resisting arrest (LA Times).

In Palm City, Florida, a 40 year old man was charged with domestic battery after he used a stun gun (reportedly not a Taser) on his 14 year old son for not obeying him to stop wrestling with his brothers (AP via ABC News).

Haven't had enough?

In Florida Miami-Dade County police used a Taser on a 6 year old emotionally disturbed first grader who broke some glass and was threatening to hurt himself with it (via Prison Planet).

"I couldn't imagine why a police officer would use that kind of device on a child," said Marvin Dunn, a psychology professor at Florida International University who was formerly a principal at an alternative school. "I can restrain a 6-year-old with one hand. I don't get it." [snip]

Miami-Dade police policy prohibits the use of Tasers only against pregnant women. Before the officer used the stun gun on the boy, Miami-Dade Officer Yolanda Rivera, who was on the scene, called a sergeant and verified its use was within department policy.

Rossman said the department's administration was reviewing its Taser policy.

Dunn said there are methods of physically restraining children and dealing with emotionally disturbed children. Clearing the room and having just one person speaking calmly to the child could have been one option, he said.

"You simply escalate the situation when you bring more adults into the picture," Dunn said.

Sunday, January 30, 2005

10 year old Vietnamese girl has died. Victim number 12.

It is often easy to forget there are people behind the numbers. Someone's older or younger sister, best friend, their little girl. So I am posting her picture (from Agence France Presse).

A 25 year old Cambodian woman has been hospitalized in Vietnam in critical condition and is on a respirator (see Recombinomics for details). She lived in a Cambodian province bordering Vietnam. Bird flu is the presumptive diagnosis.

Update (1/31/05): The Cambodian woman has now died . It is reported her young brother had also died before being seen by medical care. If confirmed due to H5N1, this would be Cambodia's first death from bird flu. Meanwhile, another death is under investigation, a 39 year old man from Danang in the central highlands. If confirmed, this would be the central region's first case.

In addition, it is reported that seven more hospitalized cases are under investigation by Vietnam's National Institute of Hygiene and Epidemiology (update info from ABC News).

Iraq: eyes wide shut (link fixed)

While we gird ourselves for the spin machine's glorification of the Iraq "elections," take a look at the images on Trevor Davis's blog. If you can. These are the faces of suffering, courtesy the US taxpayer, among others.

A recent epidemiological study in The Lancetestimated the deaths caused directly by the invasion and occupation in statistical terms. The late Irving Selikoff, one of the last century's great epidemiologists, used to say that statistics were people with the tears wiped away. Take a look at the tears. And weep.

"Botanical antiviral": caveat emptor

There are reports from various news sources today that a "pharmaceutical" manufacturer and a distributor are "working with government and hospital officials in Southeast Asia to provide VIRA 38 for the treatment and prevention of bird flu (H5N1). VIRA 38 is on the market in Hong Kong and will be available in China and Taiwan soon."

Let me say first I am extremely skeptical of the claim that "VIRA 38", an alleged "broad spectrum anti-viral" made from botanical products, is truly effective at anything except lining the pockets of its purveyors. The further claim that VIRA 38

is known for its effectiveness in treating and preventing influenza. VIRA 38 has recently been shown to contain compounds that inhibit the bird flu (H5N1) virus. Researchers at the Chinese University of Hong Kong, have previously discovered these same compounds to be effective against a variety of pathogens including SARS CoV, the virus responsible for causing severe acute respiratory syndrome

comes without any citations or supporting documentation. I judge it highly unlikely to be true, have no reason to believe it, and have plausible reasons to think it is false.

I am purposely not linking to the company or its distributor or giving their names. Should it turn out that this is truly an effective over-the-counter preparation, we will likely have confirmation soon enough. In the meantime, expect more such claims as anxiety ratchets up.

"We're Number One! We're Number One!"

And not by a little: rates of disease and disability three times higher than in other industrialized nations (Amanda Gardner, HealthDay Reporter). Using 1998 national data on sexual health and reproduction, surveillance systems for infectious diseases, hospital and outpatient statistics, birth and death records as well as published research, CDC researchers estimated public health burden in terms of the adverse health consequences of infertility, cervical cancer and HIV infections (study published in the Jan. 27 issue of the British journal Sexually Transmitted Infections). As measured by Disability Adjusted Life Years (DALYs) and premature deaths, STDs accounted for 20 million adverse health consequences and about 30,000 deaths (1.3% of US deaths). If HIV/AIDS is included, men constituted 2/3 of the deaths, but without HIV/AIDS, women were almost 90% of the deaths (from cervical cancer, associated with human papilloma virus, a sexually transmitted viral infection). (hat tip, Sam Dawes, for correction).

That's one (of many) reasons to oppose the Republican push to require teenagers to have parental consent (see here and here) for seeking reproductive health services. It is an assault on women with potentially fatal outcome.

Or maybe it's just a "family values" example of justifiable homicide for disobedience?

Saturday, January 29, 2005

Environmental red scare

The Nebraska Republican Party is scared to death. They cite the case of feedlot owner David Dickinson, whose 12,000 cattle each take in 25 lbs/day of high-grain diet on one end and put out 9 lbs of manure on the other end, producing a total of 54 tons every 24 hours. The result is a pile of manure 100 feet long, 30 feet high and 50 feet wide. Three months ago (about the time of the election) it underwent spontaneous combustion. The fire is threatening the health and welfare of the nearby residents (CNN.com).

The problem, as the local Red State fathers see it, is that they produce even more manure per day. "What if we spontaneously combusted?" one was heard to ask. Who would save the unborn?

Not to worry. There seem to be enough Democrats these days willing to fill in.

Bird flu sites

The lack of attention to the bird flu problem by the American media is perhaps not surprising (figuring out what's important and then telling us has not been their strong suit), but the similar lack of attention by the blogosphere is. However there are bloggers (besides us, that is) who have paid attention. Judging from the traffic on this site, there is considerable interest out there, so here are the links:

Just a Bump in the BeltwaySimilar to this site in some ways, although not concentrating on public health. Melanie has persistently and accurately kept avian influenza in her sights.

RecombinomicsNot exactly a blog, Henry Niman's company site has a wealth of up-to-date information on influenza. Suited to technically confident visitors with a good handle on the existing situation. Part of my daily read.

Center for Infectious Disease Research and Policy (CIDRAP)
Website of the Center at the University of Minnesota run by Mike Osterholm. Full of extremely useful information on infectious diseases and authoritative background information and news about bird flu.

ProMed MailAlert service used by many public health professionals that includes reports from everywhere on emerging infectious diseases, including avian flu. Tends to lag a bit behind the other sources.

CDC Avian flu siteUsually a day late and a dollar short, but background information conveniently arrayed.

Dismaying and predictable

The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota has an interesting, dismaying and utterly predictable report on the WHO executive board meeting January 24. Citing an AP report (I was not able to find it) the board foundered on a resolution that would have allowed countries to ignore drug patents in the event of an influenza pandemic.

The patent override was suggested by the delegate from Thailand, which is in the midst of trying to halt a spreading epidemic of influenza A(H5N1) ("bird flu") and is a neighbor to Vietnam, where an epidemic amongst poultry already rages and human cases and deaths are being reported almost daily. The Thai delegate wished to add the patent provision to a resolution on ways to improve disease surveillance and augment research and stockpiling of vaccines, when and if one becomes available for H5N1.

The cost of a 6 week course of antivirals is about $120, beyond the reach of the nations now struggling to contain the disease (see previous post on the ethical and public health issues involved in distributing antivirals). The opponents of the resolution were delegates from the US and France, where major pharmaceutical interests are involved in vaccines and antivirals.

As I said, as dismaying as it is predictable (or as predictable as it is dismaying, take your pick).

Reuters Alertnet now reports that Hong Kong residents and mainland Chinese tourists are buying up available pharmacy supplies of Tamiflu. While a prescription drug, it is easily obtainable over the counter, with no questions asked. There is concern that indiscriminate use might lead to the development of resistance to what is now considered the drug of choice of H5N1.

"I'm worried the Hong Kong government won't respond quickly enough or take tough enough measures to prevent a mass outbreak," said one foreign resident who rushed to buy supplies for his family after word of the latest deaths.

"Doctors and hospitals could be completely overwhelmed ... it might be hard to get medical aid," he said.

[snip]

Public fears mounted after media reports that Chinese exports of geese and ducks to Hong Kong had dropped sharply in recently weeks. China said it was due to stronger demand on the mainland, but many Hong Kong residents were not convinced.

The deadly SARS virus first emerged in southern China in late 2002 and quickly spread to Hong Kong and then around the world. Chinese authorities initially suppressed news of its spread.

The bottom line was summed up nicely by WHO's Dr. Dr. Anarfi Asamoa-Baah:

As a global community we are still ill-prepared—and as long as one of us is not prepared, none of us is prepared.

Pizza and coronary artery bypass: one stop shopping

Speaking at the Cleveland Clinic, President Bush pitched electronic medical records, calling on

doctors and hospitals . . . to move their medical records from paper to electronic files, a change that he said would improve medical care while shaving significant sums from the nation's spiraling health care bill. (WaPo).

Friday, January 28, 2005

Bird flu: update

This blog was not intended to be a bird flu site, but the lack of attention by the major news media in this country suggests frequent updates would be useful to those interested in this subject. Moroever, the response to bird flu is symbolic of the lack of priority given to genuine public health problems by the federal government (in comparison to other issues of lesser importance to the life, health and welfare of its citizens), and symptomatic of the lack of leadership in public health generally. So we will continue to post on it until this seems no longer useful.

The disease among bird continues to spread in Thailand. A third Thai province is now reporting H5N1 influenza in chickens and more than 400 wild pigeons have been culled in central Thailand following the discovery of a single infected pigeon in mid-December (but not reported in the usual poultry reports). (AFP via ABCNews [Australia])

Vietnam is setting up a nationwide system to try to stop the spread of the disease, which this month has spread to 27 cities and provinces and led to the forced culling of over 800,000 birds (News24, South Africa)). Details of the new effort are still not clear, but what is clear is that they are making a major effort to confront the problem. The Vietnamese equivalent of CDC will collect samples (blood?) from people at high risk for infection (poultry workers?) and individuals in "bird flu hot spots." If properly implemented such a system could produce extremely valuable information, assuming there is sufficient time.

China will vaccinate poultry and supervise markets and live poultry transportation. Japan is stockpiling the antiviral oseltamavir (Tamiflu) sufficient to treat 20 million of their population of 127 million people. The US reportedly has a total of 6 million doses for our 300 million people (see previous post). Japan is also readying plans to limit travel abroad and at home and to close schools if a pandemic begins. Hong Kong has strict vaccination requirements for chickens and plans to double its Tamiflu stocks (via Reuters Alertnet)

The Italian health ministry has called a meeting for February 3 to "make an analysis of the risk on the base of current new information and pinpoint possible scenarios . . . There is a real danger for public health which doesn't allow for delays" in strategy, according to a ministry statement (AP via ninemsn [Australia]).

Meanwhile, two Vietnamese girls (10 and 13 years old) in the south are the latest to test positive for H5N1 infection. Both are in critical condition and on respirators. The mother of the 13 year old died several days ago. They had slaughtered a duck previously (time interval not known from this report). The 10 year old's family buried sick birds at the house a month previously (this seems a rather long incubation period) (via ChinaView). The disease claimed a tenth victim in the north (News24, South Africa). Five more people in Vietnam are suspected of having contracted the disease and been admitted to the hospital (EastDay, PR China). Thus the total cases since the end of December appears to be 16, of whom 10 have died as of this date. It is difficult to keep track of the individual case reports coming out of Vietnam, so the numbers are continually being revised as better information becomes available.

Update (1/29/05, 12:30 AM EST): The 13 year old girl has now died, making this the 11th death this month. The 10 year old remains in critical condition (Channel NewsAsia).

The virus continues its mutation. Henry Niman reports on some new information at Recombinomics.

Update (same day, 11:45 am EST): Things continue to move as more health authorities recognize the magnitude of the problem. The Manila Times is reporting that the Philippines will continue to ban all poultry imports from affected areas; install disinfectant footbaths at seaports, airports and poultry farms; and forbid capture or killing of migratory birds (a seasonal practice in some areas of the Philippines). Farmers will be encouraged to keep livestock away from lakes and marshes where wildfowl are prevalent. In addition, surveillance will be increased and pamphlets on bird flu distributed nationwide.

Update (same day, 3 pm EST): Malaysia, is the latest government to sound the bird flu alarm (Daily Express News, Kuala Lumpur, Eastern Malaysia). It has placed its 135 hospitals and 4000 clinics on high alert in the event bird flu makes its way from Thailand and Vietnam.

Update (same day, 8:30 pm EST): Word is now on the far east wire services that Vietnam has deployed armed riot police at checkpoints around Ho Chi Minh City (formerly Saigon) in the south where bird flu is epidemic among poultry and some dozen human cases have occurred (Reuters via Khaleej Times, Dubai). These armed police are augmenting traffic police who are checking and monitoring poultry transport into the city to stop infected or uncertified birds from entering. Authorities have started to destroy chickens and ducks of unknown origin. Reports suggest that this has sparked resentment among the affected population. Travel agents are being instructed not to take tourists to areas now burdened with infected poultry.

At this rate, Americans will soon be the least informed people in the world regarding bird flu.

Friday Catfloggin'

Friday is usually Blogrollin’ day, where we highlight a blog—for whatever reason. Because we like it, we hate it, because we think it will do someone some good. This was a great suggestion from Political Site of the Day (PSotD), meant to replace the ubiquitous Friday catblogging. But today I want to do catblogging.

Actually, I don’t much like cats. I’m pretty much a dog person. But this thing is just so weirdly fascinating--and it even has some public health content. It is also too long to paste the whole thing in, so here is the link (via Cruel Site of the Day) where you can take in the full argument to your heart’s content. Here is a taste of what you’ll find (the bracketed sub-headings are mine). Bon appetit:

Are cats for true Christians? Is it appropriate for a Christian to own a cat, in light of their past pagan religious affiliation and the medical information that is now coming to light? -J.R., U.S.A.

It would be misleading to answer this question with either a simple 'Yes' or a 'No.' The Scriptural answer of necessity must be a 'qualified' one, and it is easy to see why. Many conscientious ones among Jehovah's people today have wondered if Christians should own cats in view of their somewhat sordid symbolic history and the many health risks associated therewith. [snip]

[Cat means beast in Greek]

First, let us consider what most scholars agree is the etymology (word derivation) for the English term 'cat'. When analyzed with the Latin 'felis cattus domesticus', the original Koine Greek is 'cur.io huma bes-tia', means 'a contemporary housecat with all of its beastly identifying characteristics and behavior.' A faithful servant of Jehovah would quickly notice that the nature of a cat is so marked as being 'beastly'. The Bible makes clear reference to this condition when describing parts of Satan's organizations, both past and present. [snip]

[Cats should be classified with snakes]

Clearly, the Bible - by using this kind of terminology - shows beyond any reasonable doubt that the basic nature of cats, while created perfect by God, has become evil or 'beastlike' since the fall of Adam six thousand years ago, and more probably, since the Great Flood of Noah's time (c2350 B.C.E.). This is a development of the condition borne by the 'Original Serpent', the 'Great Dragon' Lucifer himself. (Gen. 3:1) Indeed, modern studies of classification of cats, while not necessarily being reliable as they may be based on the discredited 'theory' of evolution, strongly associate felines with serpents (despite some external differences in physiology and morphology, which confuse those who do not study these matters deeply). [Chris Mooney, Pharyngula and your ilk, take notice!] [snip]

[Cats were not, not present at the Party]

The Bible does not say that cats were not present at Herod's birthday party when John the Baptist was beheaded. History shows that cats were most likely present at this tragic party that Jehovah did not approve of. Clearly then, as loyal Christians, why would we even want to associate with animals that are without a doubt of such bad influence, remembering how true are the Bible's words: 'Bad associations spoil useful habits'! -1 Cor. 15:33. Some have exposed themselves to possible spiritual contamination in this way. To invite cats in our house is to toy with disaster. Can one deny that the chance exists that the same grave consequences could visit your home that fell upon John? Clearly, God disapproved of this 'birthday' party. Should we not then disapprove (without showing any malicious intent, only Godly hatred) of cats the way the scriptures recommend? [snip]

[Cats might create a condition of hospitalization]

But, the most modern scientific evidence also supports the Biblical view. Contrary to popular beliefs among worldly people, cats are unhygienic animals. Recently the Centers for Disease Control (CDC) announced that 'Cats .. can shed Salmonella in their feces, which can spread the bacterial infection to humans'. Salmonella (salmonella typhimurium) creates a condition of 'week-long diarrhea, abdominal cramps and in some instances, hospitalization.' Would we be showing the proper respect to our life, Creator and to our 'neighbor' by exposing ourselves and others to this potentially deadly disease? [snip]

[Cats don’t get married]

Additionally, cats practice many unclean habits not befitting a Christian household: coughing up fur balls, licking inappropriate body areas on their own bodies (inappropriate handling) and even, in some cases, on the bodies of their human owners (wrongful motive?), urination on the floor, vocal and blatant promiscuity (unknown to any other species, all others being endowed with Godly chastity and decorum) and widespread sexual misconduct without the benefit or sanctity of holy matrimony, even orgiastic practices, substance abuse of catnip (an intoxicating herb) which produces conditions akin to drunkenness, stealing food from the table, producing ungodly sounds, excessive playfulness and the employment of devices not known to have been used by Jesus, the conducting of its unholy business under the cover of the darkness of night, and so on. [snip]

[Cats eat meat and don’t even cook it first]

It must not be forgotten that the feline is a killer. It eats mice and their kind, which is forbidden to Christians and their pets (Lev. 11:29, Isa. 66:17). But, far more serious, is the matter of the wanton consumption of the undrained corpses of the victims of this nocturnal creature; eating bodies filled with God's sacred blood is not a matter to be trifled with (Gen. 9:3,4; Lev. 3:17; Deut. 12:16,23,24; Acts 15:20,28,29). . . [snip] . . . [W]e have shown that it would be improper for a Christian to permit a veterinarian to give blood transfusions to his pet, for animal feed known to contain blood to be served to a pet or a farm animal under one's jurisdiction, or to employ any fertilizer that is known to have blood in it (w64 2/15 127-8). By allowing one's cat to roam uncontrolled, the Christian becomes a willing party to, even a conspirator within, this serious breach of God's law of life. [snip]

[It’s OK for a cat to get stoned]

The question of how to dispose of one's unwanted cat is a serious matter. Would it be proper to hand over such a creature of Satan to a person of the world? l. . . [snip] . . . If, on the other hand, [you took the view] that the pet or any other animal is under the ultimate jurisdiction of a Christian, who therefore bears responsibilities (Eccl. 12:13,14; Jas. 4:17, 1 Pet. 3:21) that are essentially parental in nature. The cat is a dependant. In harmony with this, surely it is the parent's obligation before God to ensure the feline pet is treated as one would an unruly child who repeatedly refused to obey its parents, or of one who committed apostasy. Unfortunately in the case of human offspring, one is limited by the laws of the higher authorities of the land as to what scripturally-ordained punishment may be meted out, as compliance with both sets of laws is necessary in such areas. This may not always be the case in terms of felines, where the fact that we are not living in theocratic countries may not prove such an impediment to what God requires of us, as manmade law may not afford such unmerited protection to cats as it does to humans. [snip] 'Then all the men of his city must pelt him with stones, and he must die.' . . . [snip] . . . We are not living today among theocratic nations where such members of our fleshly family relationship could be exterminated for apostasy from God and his theocratic organization, as was possible and was ordered in the nation of Israel in the wilderness of Sinai and in the land of Palestine. 'Thou shalt surely kill him; thy hand shall be first upon him to put him to death, and afterwards the hand of all the people. And thou shalt stone him to death with stones, because he hath sought to draw thee away from Jehovah thy God. . . [snip] . . . Of course, we can take no legal responsibility for anything which results from your voluntary application of your interpretation of such Biblical principles as you may believe that we have brought to your attention.

[Cats are OK during Bush’s second coming]

As loyal followers of Jehovah's thinking on this matter, we can rejoice in the fact that in the new system, the incoming theocracy and World Order, the 'lion will lie down with the lamb' -Isa. 11:6-7. Yes, when Satan is finally abyssed, the 'beastly' nature of felines will be forever abolished, and they will be fit companions for humans on Paradise Earth! [snip]

For those interested in something completely different, on January 30, Brent Rasmussen's Unscrewing the Inscrutable will host the first Carnival of the Godless. Posts from a godless perspective from all over god's green earth have been submitted and selected by the organizers. You can read Effect Measure's entry there (actually link back to it here). And if you have one of your own, today (January 28) is the cut-off for submissions.

Thursday, January 27, 2005

Bird flu: select agents and red tape

If you want to know how badly coordinated the federal effort on bird flu is, consider this piece (from Henry Niman at Recombinomics)

US Classifies Pandemic Flu Vaccine as a Select Agent

Recombinomics Commentary
January 24, 2005

One of the more interesting facts to emerge from the University of Michigan symposium on Pandemic Influenza: Could History Repeat Itself? was the fact that the US declared the flu virus a select agent because it had been genetically modified to REDUCE its lethality.

Highly pathogenic influenza A virus, including H5N1, have a poly-basic cleavage site in the hemagglutinin protein. To make the virus less lethal and enhance virus production in eggs, several of the basic amino acids are genetically removed,.

However, the removal of these sequences placed the virus in the "select agent" category, requiring background checks and paperwork that would significantly delay development of the vaccine. WHO has been pushing for programs to delay the looming pandemic, saying [.pdf] that each day allows for 5 million more doses of vaccine to be made.

It wasn't clear how long it took to get the designation removed, but the clinical trials scheduled to begin this month are now at least 4-6 weeks away for Aventis. Chiron is stated to begin even later because they built a special testing facility for pandemic flu vaccine development.

Bird flu is looming large as the red tape flows out of Washington.

To understand exactly what this designation means practically, here are a few requirements for working with a Select Agent (from the CDC FAQ on Select Agents):

18. Who has to have a security risk assessment?

All entities (except for Federal, State, or local governmental agencies), the RO [Responsible Official of the institution], alternate RO, and all individuals with access to select agents or toxins must have an approved security risk assessment. Please see our website http://www.cdc.gov/od/sap/securisk.htm or the FBI website http://www.fbi.gov/terrorinfo/bioterrorfd961.htm for additional information. [my emphasis]

Section 73.8(b)(Security risk assessments) states that an entity may not provide an individual access to a select agent or toxin unless the individual has been approved by the Secretary of either HHS or USDA, based on a security risk assessment conducted by the Attorney General. "Access" as it is used in these regulations takes its ordinary meaning: "the freedom or ability to obtain or make use of." Anyone, including visitors, who have the freedom or ability to obtain and make use of a select agent or toxin, must be approved. Also see section 73.11(d)(1) (Security). However, the regulations do recognize that access to a select agent or toxin can, as a practical matter, be limited by either security containers or by escorts. As provided in 73.11(d)(2) regarding non-laboratory functions including routine cleaning, maintenance, and repairs, non-approved individuals will be allowed access to areas where select agents are accessible only if they are escorted and monitored by an individual who has been approved. It is the intent of the regulations that the escort will have the means and ability to prevent the non-approved individual from obtaining or making use of any accessible select agent or toxin in that area.

With regard to record keeping, Section 73.15(a) requires that an entity keep an up-to-date list of everyone who has been approved for access to select agents and toxins. Section 73.15(c)(1) requires that an entity must maintain a record of each individual who has actually accessed a select agent or toxin. Section 73.15(c)(2) requires that an entity must maintain a record of each individual who has actually accessed any area where select agents are used or stored. Depending on the circumstances, maintenance of some of the records may be manual or electronic (e.g., electronic key cards that records access to labs). The record may consist of one list or three, but each section of the regulations requires the entry of specific information. For example: For a researcher working directly with a select agent or toxin, the record must show the name of the researcher; the name of agent or toxin; if long-term storage or holding was involved, the dates of removal and returns; and, if a toxin, the quantity removed and returned. Another example: For a maintenance person doing routine cleaning of an area (i.e., a lab) in which a select agent or toxin was stored (even locked storage), the record must show the name of the person who had entered the area, the date and time the person entered and left; and, if escort is required, the name of the escort.

20. What is the general process for obtaining a security risk assessment (SRA)?

The following process applies to a new application or an amendment to an existing application.

* The entity Responsible Official (RO) submits an application or amendment that includes a Table 4B (CDC Form 0.1319/USDA Form 2044) to their lead agency (APHIS or CDC, but not both). The lead agency serves as single point of contact for an entity and is responsible for coordinating all activities and communications with respect to new applications or amendments;
* The lead agency issues back to the entity a letter with the unique Department of Justice (DOJ) identifying number for each individual listed on the Table 4B or amended 4B;
* The RO forwards to each individual their unique DOJ identifying number;
* The individual fills out FBI form (FD-961) and puts their unique identifying number in block 17;

* The individual follows all of the FBI instructions (http://www.fbi.gov/hq/cjisd/takingfps.html) for submitting fingerprints; and

* The individual mails the FD-961 form and fingerprint cards as one package directly to the FBI, Criminal Justice Information Services Division (CJIS), not to APHIS or CDC.

Texan to sell earth's ecosystems

Here's something that won't surprise you: Decisions Investments Corporation of Texas is looking to sell the earth's environment. Or their piece of it. They own Biosphere 2, the 1.27 hectare glass-enclosed attempt to replicate various of earth's ecosystems (Science Magazine, 307:349, 2005). Built in the 1980s by another Texas billionaire, the facility (located in Oracle, AZ) has been plagued throughout its life (on earth) by technical problems, like maintaining proper oxygen and carbon dioxide for its resident "bionauts" who were meant to test whether humans could live in the sealed collection of mini-ecosystems. Columbia University took a crack at maintaining the facility but bailed out in 2003.

So DIC is selling the ecosphere to the highest bidder. Of course this is just a miniature ecosphere within a larger ecosphere. And maybe inside it is another one. And maybe outside the one we live in is another one, too. All owned by Texans.

Looked at in that light, the statements of DIC VP Martin Bowen take on new meaning: "we are seeking a right (sic) buyer who can keep the project going for the long term." Sounds like The Plan to Save Social Security.

Wednesday, January 26, 2005

The New England Journal's bird flu articles

On Monday The New England Journal of Medicine (NEJM) provided Early Release on-line versions of three articles related to avian influenza A(H5N1). [NB: These articles were available without subscription until today, when the print version was published. The NEJM's practice shutting off Open Access to material of such importance is not just annoying but irresponsible. Links are provided below for those wishing to purchase individual copies or who have subscriptions or access through their institutions.]

The main paper is an original research article, detailing an investigation into a cluster of three cases in Thailand in the summer of 2004. It shows likely person-to-person transmission from an 11 year old girl (who may have had contact with infected birds) to her mother and to her aunt who both cared for her during her fatal illness (Probable Person-to-Person Transmission of Avian Influenza A (H5N1), K. Ungchusak and Others ). The mother died but the aunt, treated with the antiviral oseltamavir (Tamiflu), survived. Examination of the genetic sequence of available viral specimens did not suggest that a fundamental mutation allowing facile human-to-human transmission had occurred in the virus. Thus this appears to be an example of the rare person-to-person transmission of the disease which has been suspected in some other circumstances, but not documented as here.

But what if recognized transmission does begin to occur in a limited geographic area? Isolation and quarantine, which have proved effective against the severe acute respiratory syndrome (SARS), will probably not be sufficient to stop the spread of such an infection. Vaccine specific for the new strain will not be available for months after its appearance in humans . . . .

We know that the neuraminidase inhibitor oseltamivir inhibits the type A (H5N1) viruses. It might be possible to achieve local control of an incipient outbreak among humans by using oseltamivir for prophylaxis in the contacts of patients as well as for treatment in the infected persons themselves. Treatment of patients alone would not prevent further spread, but it might reduce the shedding of the virus and would, in any event, be required for ethical reasons. All these actions rely on early recognition through good surveillance and the ability to deliver the antiviral drug at a time when transmission might still be inefficient.

The logistic hurdles are formidable. A mobile stockpile of the drug would have to exist and be made available in the affected country. Oseltamivir is now being stockpiled by a number of developed countries for use once a pandemic virus becomes established and begins to spread rapidly around the globe. Developing a stockpile in an attempt to restrict the spread of the new virus at its source might mean diverting drugs from other national stockpiles. However, this diversion must happen. The notion of trying to control a pandemic at its source would have been considered laughable just a few years ago — but that was before SARS transmission was controlled by public health measures. We have no idea whether a type A (H5N1) virus that was fully adapted to humans would continue to be highly lethal, but it is nevertheless incumbent on the global community to try to contain it.

The avian origin of previous pandemic viruses was recognized only after the fact; this time, we have been given a warning. We really are not sure when, or whether, the type A (H5N1) virus will start to spread among humans, but we must be ready to stop it if we can — and, if we cannot, at least to mitigate its effects through the use of stockpiled antiviral drugs and, eventually, strain-specific vaccine.

It should be noted that Monto properly reported he received consultation fees and grant support from Roche, the drug company that makes oseltamavir (Tamiflu). Since he is advocating the use of this antiviral it presents an unfortunate appearance of a conflict, but it is probably true that for the moment oseltamavir is the only (medical) game in town and his comments seem reasonable and plausible. Assuming this, it raises several questions.

First, what are the US stocks of oseltamavir and where are they? According to speakers on Monday at the National Bioterrorism Conference in Ann Arbor, Michigan, the US Strategic National Stockpile (SNS) has only 2 million doses of oseltamavir, although Federal officials have "talked" about increasing it to 10 million, still a woefully inadequate supply. It is estimated that there may be another 4 million doses in regular commercial channels in the US (via Pathogen Alert). We note that Hong Kong alone has 1.7 million doses and expects to double this by mid year (via Reuters Alertnet). So much for adequate planning.

But Monto's Perspective also raises some important ethical questions. Oseltamavir can be used either for prophylaxis (prevention) or early treatment. In the face of short supply, who will get the drug and how will it be partitioned between prophylaxis and treatment? Thus there are important questions of rationing and allocation for our own population.

But there is an additional, international question. Monto's Perspective implies that a country not yet affected might send its scarce supply of antiviral agent to a country where an epidemic might be getting underway, like Viet Nam or Thailand. The hope would be that we could stop the epidemic before it becomes a pandemic, thus protecting people globally. But if we miss, then the donating country would have even less stock. Australia is a country with a relative (per capita) excess of oseltamavir. Alan Hampson, deputy director of WHO's Collaboration Centre for Influenza in Melbourne has already suggested the best use might be to send a portion of it to stamp out an outbreak elsewhere (via The Australian).

Thus among the broad range of experts we will need in the event of a pandemic, bioethicists will be among the most important.

Or maybe not. We could just leave it to the good, family values-based moral judgment of the Bush Administration. Do you feel safer now?

Tuesday, January 25, 2005

Bird flu and bullshit

CDC's concerns about bird flu are just barely poking their head above water, but at least some signs are visible. The Denver Postreported this week (byline Anne Mulkern) that the agency is readying quarantine and school closure plans and examining how to ration vaccine. Since there is no vaccine for bird flu yet, this is rather curious. CDC is also asking states to get pandemic plans ready.

"The situation is different than it's ever been before" with the avian flu, said Dr. Ken Gersham, chief of the communicable-disease program at the Colorado Department of Public Health and Environment. "I think it is scary to people who know a lot about flu and what could happen."

Indeed. I think we (and others) have been saying that for some time (see links to previous posts in sidebar on left).

Now that the rest of the world is awake, we are starting to rewrite public health history in this country (from the Post story):

"When you look at health threats, here is one that we essentially know is going to happen," Dr. Bruce Gellin, director of the U.S. Department of Health and Human Services' vaccine program, said of a flu pandemic. "We don't know when it's going to happen. We don't know how severe it's going to happen."

Planning for such a pandemic began about two years ago.

Former Health and Human Services Secretary Tommy Thompson told Gellin, a specialist in infectious disease, that a national pandemic plan was his "No. 1, 2 and 3 priorities." A draft was issued in August and is posted online. No date has been set for a finalized report.

I have no doubt that there are knowledgeable people within CDC and DHHS who are, and were, scared to death of this thing. There are plenty of competent and dedicated public health professionals in the federal employ. But the implication that this has gotten the high level political support commensurate with the size of the threat is . . . well, what's that technical phrase for this . . . bullshit?

High level political support requires making a serious concern visible and public so that adequate resources can be allocated by cash-strapped state health departments who need urgent reasons to shift around the paltry contents of their shrinking pots of money. This didn't (and wasn't going to) happen during the election campaign when the Bush Administration didn't want to remind people about the flu vaccine fiasco, how dependent we were on the rest of the world or how we face threats not related to the "axis of evil."

Meanwhile, the ninth fatality has occurred in Viet Nam, a 17 year old (via Pro Med). Teenagers and young adults are disproportionate victims, unlike usual influenza were it is the very young and the very old.

There is always concern about "creating panic" by being too frank about the possibilities, given there are also significant uncertainties. Sometimes public anxiety is useful, however, and this is one of those times. As we have noted before, the Bush Administration has never been shy about issuing frightening alerts when it suits their purposes. But in this case, they would also be alerting the public to the fact that adequate preparation for a tangible threat has not happened, a threat of reasonable probability that would make an al Qaeda attack and even the tsunami look like a powder puff .

Is this an Administration that we can trust to "keep us safe"? Some questions answer themselves.

Lakoff - XI: The Moral Toolbox

[Preamble: This is one of a series of posts about the relevance of the work of George Lakoff for public health. First a disclaimer. My aim here is not an explication of all of Lakoff, or where he stands in cognitive science versus analytic philosophy, or whether there is a "there, there" as Gertrude Stein once wondered about Oakland (where Lakoff is now situated at UC Berkeley). It is rather to take some elements of Lakoff's writings (and I think genuine insights), and see how they might illuminate a central problem in public health, having a Central Problem. Posts will be relatively short, as befits the medium. PF is Lakoff's book, Philosophy in the Flesh (1999). MP is Moral Politics (2002)]

It is time to sum up Lakoff's underlying theoretical machinery. This will bring us to his Family Metaphor for Politics, the point where most people begin. I have started much farther back in Lakoff's thinking because I believe its value lies less in the specific formulation and more in the underlying method. As one passes from his earlier work to his most recent precis of MP, Don't Think of Elephants, one is struck by how much of the motivating ideas drop away, until in the short, but popular summary (...elephants) none of it is left.

This has two undesirable effects. The first is that we are led to either accept or reject a specific application of his method (his particular formulation of the Family Metaphor); and second, that to the extent we accept that formulation we run the risk of using it mechanically and uncreatively. Lakoff himself has applied it to a variety of questions, sometimes very convincingly, sometimes much less so. To the extent one finds his analysis unconvincing one might also be led to reject the whole package. I think this would be a grave error as there is much of value there. And to the extent we allow him to apply it to fields with which he is very unfamiliar (and here I am talking about public health), we run the risk of winding up with an unsatisfactory analysis. It seems to me that if one sees value in some or much of what Lakoff has alerted us to (see Lakoff VII), it is better that a Lakoffian analysis be done by experts in an area who appreciate the method than by someone who is a Lakoff expert unfamiliar with the content or by an expert in the content ignorant of the method.

After ten posts I will summarize (appropriately enough) with a metaphor of my own, the Moral Toolbox.

When we think politically, we reason with moral concepts. That reasoning is done metaphorically, that is, it uses images, concepts and bits and pieces of grounded experience that is not itself specifically moral. There are many such metaphors in our moral concept toolbox, although they don't all produce the same results and not all are equally useful in all circumstances. The tools themselves are derived from living in the real world (they are embodied). Our politics are largely determined by which tools we prefer to use when making political and moral inferences.

You can think of identity politics in terms of these tool preferences. Do you think of yourself as a plumber or a carpenter? This will determine which tools you pick up to solve particular problems. While it is true that "to a man with a hammer the whole world looks like a nail," it is also true that if you present the problem as involving a threaded pipe, even a carpenter will pick up a wrench. Carpenters may prefer hammers, but they aren't stupid and they know how to use a wrench when a wrench is appropriate. Instead of carpenters and plumbers, Lakoff presents us with Strict Fathers and Nurturant Parents. They each have roughly the same toolbox of moral concepts, but each prefers to use some tools rather than others.

Lakoff's claim in both PF and MP (but not in Elephants) is that on strictly empirical grounds, the tools the Strict Father uses will not bring about the claimed or desired effects, i.e., that the moral virtues claimed by political conservatives cannot be produced by a Strict Father morality. Lakoff considers this an established result of psychology, sociology and cognitive science. It is not an ought but an is.

Monday, January 24, 2005

Utility industry's "Quick! Silver"-therapy

Election over, it's time to recall some of the things that whizzed by us when we were otherwise occupied. Consider the Bush Administration's "Clear Skies" initiative, the perfect example of 1984-speak, seeing as how most knowledgeable observers (including a National Research Council panel) believe it will not clear the skies but make them dirtier. Among the toxins covered by Clear Skies is the heavy metal mercury, a recognized neuro- and developmental toxin (according to the EPA's own mercury website). Our chief source of environmental mercury is emissions from coal-fired power plants. Under a Clinton Administration proposal the nation's 1,100 coal-fired plants would have to reduce mercury emissions 90 percent within three years, but under "Clear Lies" they have until 2025 to reduce mercury by 70 percent. Is that clear? The cost to the utility industry, by EPA estimates, is less than 1 percent of its annual revenues (Cathy Zollo, Naples (FL) Daily News).

Apparently that's too much. Of course the utility industry is already committed to wise and responsible stewardship--of their profits. They've made substantial investments already via contributions to the campaign of President Doesn't Care and his congressional toadies which paid off handsomely, resulting in EPA stenography of industry dictated mercury rules.

We're not speaking figuratively, here. We're talking literally. A year ago when everyone was fastened on the Democratic primary campaigns, The Washington Post (link via The Seattle times ) reported that industry lobbyists had written large portions of the mercury rule. Senator Patrick Leahy asked EPA Administrator Mike Leavitt for an explanation in a written request that included as attachments a series of incriminating documents. You can see them for yourself via links here. Particularly revealing is Attachment G (.pdf), a side-by-side language comparison of the "EPA proposed rule" and industry memos/reports.

This Administration doesn't care if its mercury policy jeopardizes the potential of our children as long as it rewards their patrons in the utility industry. What does this say about their values?

My pharmacology professor in medical school used to say the only disease elemental silver was good for was "itchy palm disease." Boy, he got that right.

Sunday, January 23, 2005

Bird flu tsunami headed this way?

Since Bouphonia has done us the honor (and saddled us with the responsibility) of keeping the blogosphere updated regarding bird flu, we report the latest news. It is not reassuring.

There is another confirmed bird flu death, a 35 year old woman from the Mekong Delta (South). Add this to the death of a 17 year old boy in the North and the total is nine deaths since the end of December.

The 22 year old sister of the deceased teenage boy is now ill. H5N1 illness has not been confirmed (but see next), nor is it yet known if she cared for her brother when he fell ill. But as reported in a recent post here there is already disquieting evidence of secondary person-to-person transmission in the case of the 42 year old who cared for his (now deceased) 45 year old brother. Now comes news that a third brother, 36 years old, has been hospitalized. While all three shared a common meal of blood pudding made from ducks and pigs, they did not become ill simultaneously but at intervals of nine days each. This argues strongly for person-to-person transmission, in this case over three (viral) generations, a possible indication that human infection is becoming more likely.

Update (1/26/05, 10 pm EST): CIDRAP now reports that WHO now says (contrary to the WHO post of earlier in the day) the third brother was hospitalized only for observation and is not a case. This means this is a single person-to-person transmission of one viral generation similar to the recently reported Thai cases (see post, The New England Journal's bird flu articles, link in sidebar)

The disturbingly high case-fatality rate (in excess of 70% so far) continues. Viet Namese health authorities are also describing the severe respiratory distress syndrome as becoming "more complex." Henry Niman at Recombinomics suggests this may be evidence of further genetic changes in the virus.

Cases initially described as negative for H5N1 (the two brothers mentioned above being examples) were subsequently confirmed as positive for the virus. Niman suggests (here and here) this, too, may be evidence of a mutating virus. He makes the following important argument. Influenza A viruses have two ways to change their genetic composition, reassortment and recombination. Most of the attention has been on reassortment. The virus is unusual in that its eight genes are in separate segments. If there is co-infection with a human influenza virus, these segments can mix and match ("reassort"), to produce a virus where some of the genes can come from H5N1 and some from (say) a human H1N1. But the individual segments (genes) can also recombine "internally," so that the H5 gene from the bird can acquire some of the characteristics of the H1 gene from humans (such as being able to attach readily to human lung cells), but still look to the immune system like an H5 virus, to which we have no pre-existing immunity. A recombination affecting the H5 gene in the bird virus might be the reason that initial tests fail to confirm the disease. An H5 recombined gene, while still H5, now "looks different" to the initial tests, which are based on antibodies to an unrecombined H5.

As reported here, the disease among poultry continues to spread exponentially in Viet Nam. New data confirms this:

The Ministry of Agriculture and Rural Development reported on Saturday that bird flu has spread to 232 communes in 23 cities and provinces nationwide, with more than 500,000 chickens, ducks and quails being culled. After Hanoi and Ha Nam, Hai Duong is the third locality in the northern region to be affected by bird flu . . .

Thailand is now reporting more disease, this time including fighting cocks and chickens.

WHO remains cautious in its interpretation of these events, noting that "sporadic" human cases would be expected in an area where the disease among poultry is so widespread. But those on the spot are less hesitant (Business Day via Bloomberg):

“There is a real danger to let this wave wash away what may turn out to be a bigger problem for the country if we have an avian flu pandemic,’’ WHO representative to Thailand William Aldis told reporters in Bangkok. “The situation in Vietnam has given us all a bit of a shock.’’

So there you have it. A viral tsunami. But this time it won't "only" affect eight countries. If ever there was an issue of "Homeland Security" this is it. If this virus were a terror suspect, on the basis of public health intelligence we would be on Red Alert. They are going to blow it again.

NB: Henry Niman at Recombinomics does an excellent job of tracking developing events, although much of his commentary is technical in nature. Recommended for professionals and technically confident laypersons.

Lakoff - X: Thinking about morality metaphorically

[Preamble: This is one of a series of posts about the relevance of the work of George Lakoff for public health. First a disclaimer. My aim here is not an explication of all of Lakoff, or where he stands in cognitive science versus analytic philosophy, or whether there is a "there, there" as Gertrude Stein once wondered about Oakland (where Lakoff is now situated at UC Berkeley). It is rather to take some elements of Lakoff's writings (and I think genuine insights), and see how they might illuminate a central problem in public health, having a Central Problem. Posts will be relatively short, as befits the medium. PF is Lakoff's book, Philosophy in the Flesh (1999). MP is Moral Politics (2002)]

When we move from the experiential basis for moral concepts (discussed in Lakoff - VI) to moral accounting (Lakoff - IX) we are making the move from non-metaphoric to metaphorical thinking. Lakoff notes that while there is nothing inherently metaphoric about "Health is good" or "Everyone should be protected from physical harm" [PF, chapter 14], the incorporation of these concepts into moral conceptual systems is done through the use of metaphor. This is a basic empirical claim of Lakoff, that we think, reason and understand our experience via metaphors. Moral accounting, with its basis in the simpler metaphor of well-being as wealth, is one example. There is a certain universality about human moral conceptual systems because they are experientially grounded. But different cultures at different times might vary considerably in the more complex metaphors they use and the priority they give to different coexisting metaphors. Thus, to give one of Lakoff's examples, western thought values Moral Balance, but Japanese thought weights it more heavily than we do.

Thus moral concepts are neither completely free and unconstrained, nor are they absolute. They are not free and unconstrained because they are, as Lakoff says:

. . . inextricably tied to our embodied experience of well-being: health, strength, wealth, purity, control, nurturance, empathy, and so forth. The metaphors we have for morality are motivated by these experiences of well-being, and the ethical reasoning we do is constrained by the logic of these experiential [sources] for the metaphors. [PF p. 331].

But because our experiences of what constitutes and promotes well-being is conditioned culturally and historically, these concepts are not absolute nor do they have the same priorities for everyone. Thus Lakoff should not be accused of either moral relativism or moral absolutism. His machinery is flexible enough to avoid either. Instead our moral concepts, like other conceptual systems we use, have an "imaginative character" which allows change and adaptation as situations change and we learn and adjust.

Lakoff makes a special point that the moral metaphors with which we think and reason mostly come from conceptual structures that we would not think of as "ethical." Just as the metaphor of Love as a Journey may reason via a metaphor of vehicular travel (see Lakoff - IV for the example "Our relationship is spinning its wheels"), moral thinking often uses metaphors we would not consider to involve morality. Moral Accounting, and Well-being is Wealth, are prime examples. There are other moral metaphors as well. A pertinent one for us is Morality as Health (leading to ideas of moral hygiene, moral purity, moral soundness, being morally diseased or depraved, etc.). There is also Moral Empathy, Moral Nurturance, Morality as Strength and a number of others (see PF Ch. 14). These different metaphors are not inherently consistent and can collide, leading to different inferences. When they do, which metaphor dominates, that is, how metaphors are ordered, becomes important. Lakoff takes up this theme when he considers the priority structures of the Strict Father (politically conservative) versus the Nurturant Parent (politically liberal) moral structures. Before we get to Lakoff's notion of the Family Metaphor for Politics, we need to sum up the theoretical machinery, which we do in the next post.

Saturday, January 22, 2005

Taser "software update"

For some reason I just can't let go of this Taser thing ("Out of my cold, dead hands . . ."). They are in the news again (New York Times; and see previous posts here and here), this time because they have quietly introduced a new and improved version with 14% more stun power. For those who don't know the delightful details, a Taser is a gun that shoots a dart with an attached wire (made by the good folks at Taser International, "Saving Lives Everyday"). When it hits its "target" it delivers an electric shock (nothing major, just 50,000 volts) that causes Electro Muscular Disruption (EMD). EMD is produced by multiple electrical pulses delivered over about 5 seconds which causes the "target's" voluntary muscles to contract and relax repeatedly. That makes fine muscle movements (like walking or standing up) difficult.

How effective are they? That depends on whom you ask. Sometimes too effective, with news reports suggesting about 80 deaths. Taser says these deaths are just coincidences: drug overdoses that would have occurred anyway. That's a good one.

But wait! Some people say that they don't work well enough. Sometimes "targets" are still able to move, breaking the wires. I guess that could be a problem, because while some "suspects" might choose to run away, some might be pretty damn mad and if all you had to defend yourself was a Taser that didn't work all that well . . .

Too effective? Not effective enough? I guess by the GoldiLocks Principle, so beloved of politicians with whom no one agrees, that Taser has it "just right." But they are not resting on their laurels (which include an investigation by the Securities and Exchange Commission for possible "order stuffing" to buck up their stock prices). In their new citizen's model, the X26, the gun's software has been updated to deliver 95 pulses over 5 seconds instead of the previous 19 for the first two seconds and 15 for the last three (look for the OpenSource version on SourceForge one of these days: GNUgun?). If you are keeping count, this is 95 pulses/5 seconds compared to the old 83 pulses/5 seconds. Fourteen percent more. "We are constantly striving to optimize our technology," the Taser spokesthing said in a statement.

Oh, I probably should have warned you at the outset. Don't bother reading this if you live in the communist states of MA, RI, NY, NJ, WI, MI, HI, since Tasers aren't legal in those lawless places. But Tasers are "not firearms" so in the rest of the country they are just fine to carry and don't even require a permit (this includes California, which goes to show you . . . well, I don't know what it goes to show you).

If you want one of these nifty gadgets--just for fun, to shock your friends or to stun your co-workers--it will set you back $999 (this is a pretty good price; I wouldn't pay $1000 for it, though. They hit my price point). Here is the company's patient package insert, as we say in the pharmaceutical biz:

Friday, January 21, 2005

Hitting the bird flu snooze alarm again

I considered making this an update of the previous post, but it is really too important not to let stand on its own. WHO is now saying they believe Viet Nam's seventh death from bird flu in Hanoi infected his younger brother who was taking care of him (via Helen Branswell, CNEWS, Canada). While possible the brothers were infected from the same meal of sick duck, the nine day gap between onset of their illnesses argues against it, according to Klaus Stohr, WHO's chief influenza specialist in Geneva. At this point there is no evidence of further transmission in the family or the immediate community, but if confirmed this would be the fifth case of person-to-person transmission of H5N1 since the disease appeared in humans in 1997.

"I still am absolutely convinced that it is still just a matter of time in Southeast Asia before this thing blows," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"One day we're likely to wake up and find a number of people in a given household, in a particular work area, in a given village where we've got evidence of widespread transmission - and we no longer can account for that through bird-to-human transmission."

WHO's Stohr is equally pessimistic:

"I would like to believe that it's not going to happen. I would like to believe we will continue to see individual cases which are not going to be transmitted. I would like to believe this virus is not reassorting," he said.

"Unfortunately all the data we have would tell us otherwise.... There is too much at stake just to hope for luck."

Somebody needs to tell President Bush that it's not democracy and freedom that is likely to spread around the world under his "leadership." Instead of cavorting at obscenely costly inaugural events he should be instructing his public health establishment to sound the alarm that we may soon come under attack by a Virus of Mass Destruction.

Unfortunately the response to the Viet Nam wake-up call seems to be to hit the snooze alarm once again. Just a few more minutes sleep, please.

Many people voted for Bush because they thought he would "keep us safe." Now that's irony.

Still more bird flu in Viet Nam - and Thailand

With the death of an 18 year old woman, the toll from bird flu in Viet Nam has now reached six since early December. Xinhua Net (PR China) is reporting that WHO has been told by Viet Namese officials there are up to ten more suspect cases under investigation, four in the North (Hanoi), two of which are on respirators. Viet Nam has banned imported poultry and distributed hundreds of thousands of informational brochures warning against eating sick birds or coming in contact with them. This is a time (Lunar New Year) when poultry is a traditional holiday dish throughout the country, a symbolic offering to a family's ancestors. The disease continues to spread among poultry as well, with a reported case in a chicken in neighboring Thailand, an indication the epidemic is moving beyond Viet Nam. Thailand is on high alert. Migratory wildfowl such as ducks may be the source.

Appropriately, WHO is increasing the urgency of its warnings:

. . . recent epidemiological and laboratory studies revealed unusual features that "suggest that the virus may be evolving in ways that increasingly favour the start of a pandemic", the agency said in a report to its bi-annual executive board, which is meeting this week. (via Reuters)

Among the worrisome changes are an increase in environmental persistence and survival of the virus, an expanding range of species, including mammals, and the presence of the virus in migratory wildfowl, especially ducks, that are themselves healthy but excrete large amounts of virus highly pathogenic for chickens. The common practice of keeping backyard domestic chickens and ducks in rural areas means there is a potential for substantial human exposure. One scenario of great concern would be co-infection of a person with both H5N1 avian virus and a commonly circulating human strain (e.g., H1N1 or H3N2). The result could be a reassortment of genes leading to a new avian virus adapted to and easily transmissible between humans. If such an event were to occur it is possible the new virus would be less virulent in humans than the current H5N1 but no one knows. The worst case is a 1918 style (or worse) pandemic with a highly contagious influenza virus against which there is no natural immunity in humans.

If this happens, most locales are unprepared. As WHO notes,

"Many of the public health interventions that successfully contained SARS (Severe Acute Respiratory Syndrome) will not be effective against a disease that is far more contagious, has a short incubation period, and can be transmitted before the onset of symptoms," [WHO] said.

Travel restrictions, quarantines and tracing of cases will be the main tools to protect populations, pending a boost in vaccine supplies, according to the WHO. "Each day gained could mean an additional five million doses of vaccines," it said. (Reuters)

It continues to be dismaying, if not "scandalous," that there is no greater sense of urgency coming from CDC or DHHS.

Update, 1/21/05, 2:30 pm EST: Henry Niman is now reporting on a seventh death, this time in Hanoi, thus the first in the North. As usual, he has details and sober Commentary. China Post has a pointed quote from WHO's representative in Thailand, Hans Troedsson:

"It's a bit of a disappointment to have this outbreak and the international community not responding more adequately to this threat," Troedsson said. "If you had this situation in Europe or London or New York ... you can imagine how much resources would be put toward this."

WHO has a team of four people in Vietnam working on the bird flu outbreak.

Blogrollin' Friday: Billmon

On Friday we highlight a blog we feel might be of interest to our readers (all seven of them). This idea was suggested by the Political Site of the Day blog:

Even if you regularly add blogs to your blogroll, pick one blog on Friday, add it to your blogroll, and give a little blurb as to why you selected that blog. No reciprocation needed - just a way and a day to weekly, structurally, habitually, add to the connectiveness that are blogs.

And - if you like this idea, please feel free to promote it today so others can consider it as well.

Of all the people I have discovered from blog reading, the most journalistically talented is Billmon, whoever the hell he is. It’s not so much that he is a good writer: there are lots of people out there who can write with angry terse eloquence, even if not enough do. But he is a great editor. He really understands the art of arranging fragments into a bigger story. The Independent really ought to hire him to edit their fancy pages.

Here is Billmon's Wednesday's offering:

Sounds Like Victory

From where I sit in Iraq, things are not all bad right now. In fact, they are going quite well . . . In the distance, I can hear the repeated impacts of heavy artillery and five-hundred-pound bombs hitting their targets. The occasional tank main gun report and the staccato rhythm of a Marine Corps LAV or Army Bradley Fighting Vehicle's 25-millimeter cannon provide the bass line for a symphony of destruction.

Lt. Col. Tim RyanTacoma News TribuneJanuary 18, 2005

You smell that? Do you smell that? That's napalm, son. Nothing else in the world smells like that. I love the smell of napalm in the morning. You know, one time we had a hill bombed for twelve hours. When it was all over I walked up. We didn't find one of 'em, not one stinkin' dink body. The smell — you know that gasoline smell — the whole hill. It smelled like . . . victory.

Thursday, January 20, 2005

Poll shows half of country is wrong

Praying that my grant gets funded

There is a line of thought that says the only intellectually honest position on religion is agnosticism, since any proposition on the existence of the Big Guy is not susceptible to proof or empirical demonstration. Thus both theism and atheism are matters of faith. Since I am an atheist, on the basis of that impeccable reasoning, I demand my fair share of the $1.17 billion federal money shelled out to "faith-based" programs last year (Laura Meckler, AP, via the Boston Globe).

I know I have to do more than just ask for it, so in my latest grant proposal I have included a diagram that clearly shows a cross, a Star of David and a crescent over my workspace. To those who object I don't really believe in what those symbols represent, I reply as did Niels Bohr when asked by a reporter if the horseshoe over his lab bench meant he was superstitious. "Of course, not," he replied. "I'm a scientist. But I understand it works even if you don't believe in it." So we'll see.

If funded, as a tithe, I will donate my institution's full federal indirect costs to my atheist co-religionists fighting the infidels of Intelligent Design.

Wednesday, January 19, 2005

When epidemiology is rocket science

When Russians launch their space rockets from the Baikonur Cosmodrome in Kazakhstan they also spray "dozens of litres of unburned fuel from spent rocket stages containing toxic substances" onto an inhabited area surrounding the site. US and European launch sites are over the ocean and do not result in this kind of civilian exposure. Reuters Health reports that epidemiologists from Vector, the Russian weapons laboratory in Novosibirsk, have found "increased rates of illness" in children along the flight path. The Russian report is not published, but noted as a news item in the journal Nature(subscription required) because of its "important implications." Nature also reported that Russian authorities deny the report and are attempting to suppress it.

NASA and the European Space Agency have used the facility and admitted to being aware of the pollution, but don't accept responsibility, saying they are only "buying the service" of the cosmodrome. The ever-popular American weapons-maker Lockheed-Martin also uses it.